December 15, 2020

Advances in antiretroviral therapy (ART) have improved life expectancy for people living with HIV and have all but eliminated the risk of transmission in those who achieve an undetectable viral load. Until recently, viral suppression required strict adherence to daily oral ART, but a new long-acting injectable (LAI) form of ART could make it easier to maintain viral suppression.

Dr. Karine Dubé

Dr. Karine Dubé

John Kanazawa

John Kanazawa

Published in AIDS Research and Human Retroviruses, a new review led by researchers at the UNC Gillings School of Global Public Health outlines considerations for effective implementation of LAI-ART in the United States and poses questions for clinicians and public health experts as they develop treatment strategies that help achieve the goal of viral suppression. It features the work of Senior Research Fellow John Kanazawa, JD, LLM, MPH, and Assistant Professor Karine Dubé, DrPH, from the Public Health Leadership Program in collaboration with colleagues from the University of California at San Francisco Center for AIDS Prevention Studies (CAPS).

Because LAI-ART is a relatively new type of therapy, very few data exist on best practices for adapting it into clinical care. While the treatment has shown efficacy in research, novel advancements in HIV prevention and treatment – such as pre-exposure prophylaxis (PrEP) –  have demonstrated that effective strategies require understanding the populations, contexts and processes involved in implementation.

Adherence to daily oral therapy can be challenging. And for many people living with HIV, taking a pill every day serves as a constant reminder of their condition. LAI therapy strives to overcome these challenges, but it also poses new ones that may include keeping up with clinic visits and overcoming a fear of injections.

In order to proactively anticipate the unique challenges of novel LAI-ART implementation, Kanazawa and fellow researchers conducted a scoping review of literature on LAI-ART and other fields where long-acting injectable therapies are in use. The review employed Feldstein and Glasgow’s Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework and focused on four primary areas that helped to identify key implementation questions.

  • What concerns do patients and providers have about LAI-ART?
  • At which patient population is LAI-ART best directed? Which organizations or providers are best suited to administer LAI-ART?
  • What external factors bear on the implementation of LAI-ART?
  • What is needed to craft a sustainable infrastructure for LAI-ART?

“HIV has evolved from a terminal disease to a chronic condition,” said Kanazawa. “Treatment must now focus not on preventing deaths, but on the long-term health and bettering the quality of life for all people living with HIV. We must answer these questions because, as seen with other HIV prevention and treatment modalities, the populations who may benefit the most are also the least likely to participate in clinical trials and only take up new interventions when they become widely available.”

LAI-ART represents a new direction for HIV treatment that could significantly reduce adherence barriers and improve prognoses in the United States and globally.

“As such,” Kanazawa continued, “we have an ethical and moral imperative to determine how long-acting injectable ART may be implemented to achieve its fullest potential to maintain and advance durable HIV suppression, rather than simply becoming an optional modality for those already adherent to ART.”

Read the full paper in the AIDS Research and Human Retroviruses journal.

This year, Dubé and Kanazawa have also collaborated with fellow researchers, both at the Gillings School and nationwide, on several other pieces of literature on HIV research. They are currently working on several articles focused on resolving critical ethical and implementation issues related to advancements in HIV therapeutics.

Altruism: Scoping review of the literature and future directions for HIV cure-related research

Re-examining the HIV ‘functional cure’ oxymoron: Time for precise terminology?

Reasons People Living with HIV Might Prefer Oral Daily Antiretroviral Therapy, Long-Acting Formulations, or Future HIV Remission Options

The Dose Response: Perceptions of People Living with HIV in the United States on Alternatives to Oral Daily Antiretroviral Therapy

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